Expandable thoracic access port

ABSTRACT

A surgical access assembly includes a body having first and second body members. Each body member has an opposed side and an outer side. The body members are coupled to one another by a connector and are moveable with respect to one another between an approximated position and a spread position wherein the opposed sides are flexed outwardly and apart from one another to define a passageway therebetween. A flexible membrane is coupled to the first and second body members and extends therefrom such that translating the flexible membrane radially outwardly moves the body members from the approximated position to the spread position.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/264,502, filed Apr. 29, 2014, which is a divisional of U.S. patentapplication Ser. No. 13/005,611, filed Jan. 13, 2011, now U.S. Pat. No.8,777,849, which claims the benefit of, and priority to, U.S.Provisional Patent Application Ser. No. 61/304,083, filed Feb. 12, 2010.The entire contents of each of the above applications are herebyincorporated by reference.

BACKGROUND

1. Technical Field

The present disclosure relates generally to devices and techniques forperforming surgical procedures. More particularly, the presentdisclosure relates to an access device for minimally invasive surgery.

2. Background of the Related Art

In an effort to reduce trauma and recovery time, many surgicalprocedures are performed through small openings in the skin, such as anincision or a natural body orifice. For example, these proceduresinclude laparoscopic procedures, which are generally performed withinthe confines of a patient's abdomen, and thoracic procedures, which aregenerally performed within a patient's chest cavity.

Specific surgical instruments have been developed for use during suchminimally invasive surgical procedures. These surgical instrumentstypically include an elongated shaft with operative structure positionedat a distal end thereof, such as graspers, clip appliers, specimenretrieval bags, etc.

During minimally invasive procedures, the clinician creates an openingin the patient's body wall, oftentimes by using an obturator or trocar,and thereafter positions an access assembly within the opening. Theaccess assembly includes a passageway extending therethrough to receiveone or more of the above-mentioned surgical instruments for positioningwithin the internal work site, e.g. the body cavity.

During minimally invasive thoracic procedures, an access assembly isgenerally inserted into a space located between the patient's adjacentribs that is known as the intercostal space, and then surgicalinstruments can be inserted into the internal work site through thepassageway in the access assembly.

In the interests of facilitating visualization, the introduction ofcertain surgical instruments, and/or the removal of tissue specimensduring minimally invasive thoracic procedures, it may be desirable tospread tissue adjacent the ribs defining the intercostal space.Additionally, during these procedures, firm, reliable placement of theaccess assembly is desirable to allow the access assembly to withstandforces that are applied during manipulation of the instrument(s)inserted therethrough. However, reducing patient trauma during theprocedure, discomfort during recovery, and the overall recovery timeremain issues of importance. Thus, there exists a need for thoracicaccess ports which minimize post operative patient pain while enablingatraumatic retraction of tissue and which do not restrict access to thebody cavity, as well as facilitates removal of tissue specimens from thebody cavity.

SUMMARY

In accordance with the present disclosure, a surgical access assembly,or access port, for positioning within an opening in tissue is provided.In one aspect, the surgical access assembly includes a body having firstand second body members. Each body member includes an opposed side andan outer side. The first and second body members are coupled to oneanother by a connector and are moveable with respect to one anotherbetween an approximated position and a spread position. In theapproximated position, the opposed sides of the first and second bodymembers are closer to one another. In the spread position, the opposedsides of the first and second body members are flexed outwardly andapart from one another to define a passageway therebetween. A flexiblemembrane is coupled to the first and second body members and extendstherefrom. The flexible membrane is configured such that translating theflexible membrane radially outwardly moves the body members from theapproximated position to the spread position.

In one embodiment, the flexible membrane is coupled to an adjustablemember at a proximal end thereof. The adjustable member can beconfigured to tension the flexible membrane to move the body membersbetween the approximated and spread positions. Releasing the tension onthe flexible membrane can allow the body members to return to theapproximated position. The adjustable member may include an adjustablering coupled to the flexible membrane. The adjustable ring may beselectively adjustable between a first position defining a minimumdiameter of the ring and a second position defining a larger diameter ofthe ring.

In some embodiments, one or more ribbons are coupled to the connector toremove the access assembly from the body cavity through the incisionafter completion of the procedure. The ribbon can also in someembodiments be used for manipulating the positioning and orientation ofthe access assembly.

In some embodiments, an outwardly facing surface of each of the bodymembers defines a curved cross-sectional configuration. Each of the bodymembers may also increase in thickness from the opposed sides to theouter sides thereof.

The connector can define a generally horseshoe shaped configuration andcan be connected to the leading ends of the first and second bodymembers toward the outer sides thereof.

Cushioning can be disposed on the outwardly facing surfaces of the bodymembers to protect surrounding tissue when the access assembly isdisposed through an opening in tissue.

The body members in some embodiments can be biased toward theapproximated position.

In another aspect, the present disclosure provides a surgical accessassembly for positioning within an opening in tissue comprising a bodyincluding first and second body members, each body member including aleading end, a trailing end and first and second sides. The first andsecond body members are coupled to one another and moveable with respectto one another between an approximated position, wherein a side of thefirst and second body members are closer to one another, and a spreadposition, wherein the first sides of the first and second body membersare spaced further apart from one another to define a passagewaytherebetween. The body members are insertable into the incision with theleading end oriented toward the incision, and the body member issubsequently pivotable to a transverse position, with the passagewaydefined between the body members in the transverse position of the bodymembers.

A flexible membrane extending from the first and second body membersgraspable by a user to move the body members to the transverse positionand/or to move the body members to the spread position can be provided.A locking member can be provided to selectively lock the body members inan intermediate position between the approximated and spread positions.

In another aspect, the present disclosure provides a surgical accessassembly for positioning within an opening in tissue comprising a bodyincluding first and second body members, each body member including anopposed side, a leading end and a trailing end. The first and secondbody members are coupled to one another and moveable with respect to oneanother between an approximated position, wherein the opposed sides ofthe first and second body members are closer to one another, and aspread position, wherein the opposed sides of the first and second bodymembers are rotated outwardly away from each other to define apassageway therebetween.

An outer surface of each body member can be curved and can engage aninner surface of the tissue within the incision. A cushioning member canbe positioned on the outer surface of the body members. A flexiblematerial can extend from the body members movable to rotate the bodymembers outwardly.

A method of accessing an internal cavity of a patient is also providedin accordance with another aspect of the present disclosure. The methodincludes forming an opening in the patient's tissue and providing anaccess assembly. Next, with the access assembly in the approximatedposition, the leading end of the access assembly is inserted through theopening in the patient's tissue such that the body of the accessassembly is positioned within an intercostal space defined betweenadjacent ribs of the patient and such that the flexible membrane extendsproximally from the opening in tissue. The access assembly is thenrotated such that the adjacent opposed sides are aligned with theopening in tissue. Next, the flexible membrane is translated radiallyoutwardly, moving the body members from the approximated position to thespread position and expanding the intercostal space to create apassageway into the patient's internal body cavity.

In one embodiment, one or more ribbons can be used to facilitatetranslation and/or rotation of the access assembly.

In another embodiment, the method further includes introducing surgicalinstrumentation and/or a tissue specimen through the access assembly.

The method can further include releasing the tension on the flexiblemember to allow the access assembly to move from the spread position tothe approximated position. The access assembly can then in someembodiments be rotated such that the leading end is positioned adjacentthe opening in tissue and can then be translated proximally via theleading end, e.g., by pulling one of the ribbons coupled to the leadingend, to remove the access assembly from the opening in tissue.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the subject access port are described herein withreference to the drawings wherein:

FIG. 1 is a side view of an access port according to the presentdisclosure shown being inserted into an incision in tissue;

FIG. 2A is a bottom view of the access port of FIG. 1 being rotated intoposition within the incision in tissue;

FIG. 2B is a bottom view of the access port of FIG. 1 in position formovement between an approximated and a spread position;

FIG. 3 is a side, cross-sectional view of the access port of FIG. 1disposed in the spread position;

FIG. 4 is a bottom, perspective view of the access port of FIG. 1showing a flexible membrane extending from the access port and throughthe incision in tissue;

FIG. 5A is a bottom, perspective view of the access port of FIG. 1 shownbeing removed from the incision in tissue.

FIG. 5B is a top, perspective view of the access port of FIG. 1 shownbeing removed from the incision in tissue; and

FIG. 6 is a front view illustrating a patient's skeletal structure withsurgical access port of FIG. 1 positioned within the intercostal spacedefined between adjacent ribs.

DETAILED DESCRIPTION

Various embodiments of the presently disclosed access assembly, oraccess port, and methods of using the same, will now be described indetail with reference to the drawings wherein like references numeralsidentify similar or identical elements. In the drawings, and in thefollowing description, the term “proximal” should be understood asreferring to the end of the access port, or component thereof, that iscloser to the clinician during proper use, while the term “distal”should be understood as referring to the end that is further from theclinician, as is traditional and conventional in the art. Additionally,use of the term “tissue” hereinbelow should be understood to encompassboth the patient's ribs, and any surrounding tissues. It should be alsobe understood that the term “minimally invasive procedure” is intendedto include surgical procedures through small openings/incisionsperformed within a confined space such as the thoracic cavity orabdominal cavity.

Referring now to FIGS. 1-5B, the presently disclosed surgical accessport is shown generally identified by the reference numeral 100. In theembodiment of FIGS. 1-5B, the access port 100 is depicted as a thoracicport 100 that is configured and dimensioned for insertion into theintercostal space located between the adjacent ribs “R” (FIG. 3) of apatient in order to allow for the insertion and manipulation of one ormore surgical instruments within the thoracic cavity. However, it isalso envisioned that access port 100 may be configured and dimensionedto provide access to a variety of other internal body cavities and/ortissues. Further, access port 100 may be formed from any suitablebiocompatible material of strength suitable for the purpose describedherein, including, but not being limited to, polymeric materials.

The access port 100 is configured and dimensioned to extend into a bodycavity, e.g., the thoracic cavity “T” (FIGS. 3 and 6), through theintercostal space, and generally includes a body 105 having a horseshoeshaped leading end 107 and first and second body members 110, 120interconnected by the horseshoe shaped leading end 107. A ribbon 130 isattached to the horseshoe shaped leading end 107 to facilitate removalof the access port 100 from the cavity “T” and through incision “I”after the procedure. A flexible membrane 140 is attached at a distal end142 thereof to opposed (inner) sides 112 and 122 of the first and secondbody members 110, 120, respectively, and is attached at a proximal end144 to an adjustable ring 150. Access port 100 is moveable between aclosed, or approximated position for insertion and removal, and an open,or spaced apart position wherein a passageway 190 (FIG. 3) extendstherethrough to provide access to the internal body cavity.

First and second body members 110, 120, include an outer side 113, 123,a leading end 114, 124 and a trailing end 115, 125, respectively. In theapproximated, or closed position of access port 100, shown in FIG. 1,opposed sides 112, 122 of body members 110, 120, respectively, arepositioned closer to each other, and preferably adjacent each other. End108 a of horseshoe shaped connector 108 is attached to leading end 114of body member 110, and end 108 b of horseshoe shaped connector 108 isattached to leading end 124 of body member 120. An opening 109 isdefined between horseshoe shaped connector 108 and the leading ends 114,124 of body members 110, 120, respectively.

Body members 110, 120 of access port 100 may be formed from a semi-rigidmaterial to give access port 100 structural support while still allowingfor some degree of flexibility. At least a portion of body members 110,120 can be transparent to permit visualization through the access port100 and into the surgical site. Body members 110, 120 may increase inthickness from their respective opposed sides 112, 122 to theirrespective outer sides 113, 123, as best shown in FIG. 3, and/or mayinclude cushioning 119 (FIG. 3) disposed adjacent outer sides 113, 123and extending along outwardly facing surfaces 116, 126 of body members110, 120, respectively. This increased thickness and/or cushioning 119helps protect surrounding tissue, e.g., ribs “R” and nerves “N,” duringthe insertion and removal of surgical instrumentation and/or body tissuethrough the access port 100. As can be appreciated, the increasedthickness of body members 110, 120 also allows the outer sides 113, 123to be more rigid, or less flexible, than the opposed sides 112, 122 ofbody members 110, 120, respectively. As will become more apparent below,in a preferred embodiment, body members 110, 120 have increasingflexibility from the outer sides 113, 123 to the opposed sides 112, 122such that the opposed sides 112, 122 may be moved apart from one anotherto create a passageway 190 extending through access port 100.

Access port 100 may be biased toward the approximated position whereinbody members 110, 120 are positioned closer to, and preferably adjacent,one another. In this embodiment, if the body members 110, 120 are flexedto the open position and are not retained in the open position by alocking mechanism, body members 110, 120 would return under the bias tothe approximated or closed position.

Each of the body members 110, 120 may define a similarly arcuate orcurved profile on one or both surfaces, as viewed from either theleading ends 114, 124 or trailing ends 115, 125 of body members 110,120, respectively. In other words, the outwardly facing surfaces 116,126 of body members 110, 120, respectively, may define a generallyconvex configuration and/or the inwardly facing surfaces 117, 127 ofbody members 110, 120, respectively, may define a generally concaveconfiguration. Accordingly, a saddle 118, 128 (FIG. 3) may be formedwithin each of the outwardly facing surfaces 116, 126 of body members110, 120, respectively, of access port 100. As can be appreciated,saddles 118, 128 are relatively shallow when access port 100 is disposedin the approximated or closed position (FIG. 1). However, upon movementof access port 100 to the open, or spaced apart position (FIG. 3),saddles 118, 128 become more defined for seating ribs “R” therein.Correspondingly, as opposed sides 112, 122 are moved apart from oneanother, the outwardly facing surfaces 116, 126 of body portions 110,120, respectively, become more convex, while the inwardly facingsurfaces 117, 127 become more concave.

As best shown in FIG. 3, flexible membrane 140 is generally funnelshaped when tensioned and is coupled at distal end 142 thereof toopposed sides 112, 122 of body members 110, 120, respectively. Morespecifically, a first section 140 a of flexible membrane 140 ismechanically coupled to opposed side 112 along the length of opposedside 112 of body member 110 and a second section 140 b of flexiblemembrane is similarly mechanically coupled to opposed side 122 along thelength of opposed side 122 of body member 120. A pair of end sections140 d of flexible membrane 140 connect the first and second sections 140a and 140 b of flexible membrane 140 to one another, thereby definingthe completed funnel shape, as shown in FIG. 3. In other words, flexiblemembrane 140 creates a funnel-shaped passageway 190 from the proximalend 144 thereof to the distal end 142 thereof. The funnel-shapedmembrane 140 thus extends distally with the body members 110, 120forming the distal-most portion of the funnel. As can be appreciated,the funnel is more conically shaped when body members 110, 120 are inthe approximated position, i.e., where opposed sides 112, 122 of bodymembers 110, 120 are adjacent one another, while the funnel is morecylindrically shaped when body members 110, 120 are in the openposition, i.e., where opposed sides 112, 122 are spaced apart from oneanother.

It is envisioned that flexible membrane 140 is configured for softtissue retraction. More particularly, it is envisioned that flexiblemembrane 140 has a sufficient elasticity to permit retraction of a widerange of tissue thicknesses since there may be a wide range of tissuethicknesses among different patients. It is also envisioned thatflexible membrane 140 is of sufficient strength to properly retract bodymembers 110, 120 when tensioned, to resist accidental puncture by sharpsurgical instrumentation, and to resist tearing. Additionally, it isenvisioned that flexible membrane 140 is made from a bio-compatiblematerial to reduce the incidents of adverse reaction by a patient uponcontact with the patient's tissue. The flexible membrane 140 can also bemade of a transparent material to allow the user to better view thesurgical site and surrounding tissue.

With continued reference to FIG. 3, the adjustable ring 150 is disposedat the proximal end 144 of flexible membrane 140. Adjustable ring 150may be formed from a rigid biomaterial to define a structured opening topassageway 190 which extends from the proximal end 144 of flexiblemembrane 140 through the body members 110, 120. More specifically,adjustable ring 150 may be disposed through a loop 149 formed at theproximal end 144 of flexible membrane 140. Proximal end 144 may befolded back onto and adhered to flexible membrane 140 to define loop 149therebetween. Alternatively, adjustable ring 150 may be mechanicallyengaged with flexible membrane 140 in any other suitable configuration.In some embodiments, ring 150 can be flexible to conform to the contoursof the patient's body.

Adjustable ring 150 includes structure to retain the ring in variouspositions. In the embodiment of FIG. 3, a ratcheting mechanism isprovided with overlapping ends 153, 154, each defining a plurality ofcomplementary teeth 153 a, 154 a, respectively, and notches 153 b, 154b, respectively, on opposed surfaces thereof such that teeth 153 a areengageable with notches 154 b and teeth 154 a are engageable withnotches 153 b to thereby expand or contract adjustable ring 150, asdesired, and retain the ring in the select position. Accordingly,adjustable ring 150, and thus proximal end 144 of flexible membrane 140disposed therearound, may define a minimum diameter wherein ends 153 and154 of ring 150 are fully overlapping and wherein flexible membrane 140is substantially un-tensioned, and a maximum diameter, wherein ends 153and 154 of adjustable ring 150 are only slightly overlapping and whereinflexible membrane 140 is significantly tensioned. As will be describedin more detail below, adjusting the ring diameter tensions and slackensthe flexible membrane 140, thereby effecting opening and closing (orspreading and retracting) of the passageway 190 defined between bodymembers 110, 120. It is also envisioned that any other suitableadjustable member may be used to adjust/retain adjustable ring 150between a minimum and a maximum diameter. The adjustable member 140 mayinclude a locking mechanism to lock the flexible member 140 in aplurality of positions, e.g., defining a minimum diameter of ring 150, amaximum diameter of ring 150, and/or a plurality of intermediatediameters.

As mentioned above, the flexible membrane 140 is generally funnel-shapedwhen tensioned and extends distally and inwardly from the adjustablering 150, which is disposed at the proximal end 144 of flexible membrane140, ultimately attaching at a distal end 142 thereof to the bodymembers 110, 120. Moreover, the first and second sections 140 a, 140 band end sections 140 d of flexible membrane 140 may be integral with oneanother, i.e., formed as a single membrane, or may be formed as separatesections engaged with one another via conventional means. It isenvisioned that distal end 142 of flexible membrane 140 be attached orintegral with body members 110, 120, such that the passageway 190extending through access port 100 is isolated from tissue surroundingthe incision “I.” In a preferred embodiment flexible membrane 140 andbody members 110, 120 completely shield the incision “I,” to reduce therisk of tissue damage and/or infection during the surgical procedure.

With reference now to FIGS. 2A-2B, horseshoe shaped connector 108extends from leading ends 114, 124 of body members 110, 120,respectively, of access port 100. Horseshoe shaped connector 108 may beformed integrally with or may be attached to leading ends 114, 124 viasuitable means. Horseshoe shaped connector 108 be made from a strong,rigid material to maintain a fixed spatial relation between body members110, 120. To this end, horseshoe shaped connector 108 may be reinforcedto provide further structural support thereto. Horseshoe shapedconnector 108 may be configured to maintain outer sides 113, 123 of bodymembers 110, 120, respectively, relatively fixed with respect to oneanother, while opposed inner sides 112, 122 are flexible with respect toouter sides 113, 123, thereby flexing body members 110, 120. Thus, thepassageway 190 extending through access port 100 is expandable between aminimum width, wherein opposed sides 112, 122 of body members 110, 120are adjacent one another, and a maximum width wherein opposed sides 112,122 of body members 110, 120 are flexed apart from one another and withrespect to the outer sides 113, 123 of body members 110, 120,respectively. As can be appreciated, in the illustrated embodiment, themaximum width of passageway 190 does not exceed the distance betweenouter sides 113, 123, which are maintained in fixed relation relative toone another by horseshoe shaped connector 108.

A second horseshoe shaped connector (not shown), substantially similarto horseshoe shaped connector 108 may be disposed on the trailing ends115, 125 of body members 110, 120, respectively, to provide furtherstructural support to body members 110, 120, and more specifically, toouter sides 113, 123 of body members 110, 120, respectively.

Ribbon 130, as best shown in FIGS. 4 and 5B, is disposed about horseshoeshaped connector 108 and extends therefrom. Ribbon 130 may be adheredto, looped around, or otherwise engaged with horseshoe shaped connector108. Ribbon 130 has sufficient length to extend proximally from accessport 100 out through the incision “I” to be grasped by the user. As willbe described in more detail below, ribbon 130 is configured for removalof access port 100 from the incision “I.” In some embodiments, ribbon130 can be provided to facilitate manipulation of access port 100 duringthe insertion and use of the access port 100. It is envisioned that morethan one ribbon 130 may be provided, to further facilitate manipulationof access port 100. Alternatively, or in conjunction with ribbon 130,flexible membrane 140 may be used to manipulate, orient, or positionaccess port 100.

The use and operation of the access port 100 will be now discussedduring the course of a minimally invasive thoracic procedure by way ofexample. As will be appreciated in view of the following, access port100 is easily inserted, manipulated, and removed from a patient's body.Further, the access port 100 is minimally intrusive, flexible to conformto a patient's anatomy, and provides good visibility into the thoraciccavity “T” (FIG. 3). Additionally, the funnel-shaped, low-profileconfiguration of access port 100 is particularly advantageous, forexample, in the removal, or retrieval, of tissue specimens from withinthe body.

Initially, an opening, or incision “I,” is made in the patient's outertissue wall of the thoracic body cavity by conventional means. Theincision “I” is made between adjacent ribs “R,” extending along theintercostal space. In other words, a relatively narrow, elongatedincision “I” is made between adjacent ribs “R.”

In preparation for insertion through the incision “I,” access port 100is oriented in a vertical position shown in FIG. 1, wherein thehorseshoe shaped leading end 107 is distal, or closer to the incision“I,” and wherein the trailing ends 115, 125 of body members 110, 120 areproximal, or closer to the user. At this point, the body members 110,120 are in the approximated position, preferably biased in thisposition, such that access port 100 is relatively thin and thepassageway 190 therethrough defines a minimum width, as described above,or is closed if sides 112 and 122 are in abutment as in someembodiments. This alignment of the access port 100 with the incision “I”allows access port 100 to be inserted through the narrow incision “I”between the adjacent ribs “R” with limited, if any, expansion of theincision and minimal trauma to surrounding tissue. Ribbon 130 extendsfrom horseshoe shaped connector 108 away from the incision “I” such thata portion of ribbon 130 extends from the incision “I,” as shown in FIG.1.

As shown in FIG. 1, the user then grasps the access port 100, e.g., withhis/her fingers or with any other suitable surgical tool, and advancesthe access port 100 distally through the incision “I,” led by horseshoeshaped leading end 107. It is envisioned that the leading and trailingends 114, 124 and 115, 125 of body members 110, 120, respectively, maydefine a curved configuration to decrease the likelihood of access port100 “catching” on tissue during insertion and removal of access port 100from the incision “I.” Horseshoe shaped leading end 107 and body members110, 120 are fully inserted into incision “I,” while flexible membrane140 extends proximally from incision “I.”

Once the body members 110, 120 of access port 100 are fully disposedthrough the incision “I,” as shown in FIG. 2A, membrane 140 may bepulled proximally to align the access port 100 for deployment. Morespecifically, after insertion of access port 100, as can be appreciated,horseshoe shaped leading end 107 is positioned furthest into the bodycavity, while trailing ends 115, 125 of body members 110, 120,respectively are closest to the incision “I,” i.e., access port 100 isoriented as shown in FIG. 1. With access port 100 fully disposed withinthe internal body cavity, membrane 140 may be pulled, causing horseshoeshaped leading end 107 to be pulled back towards the incision “I,”thereby rotating access port 100. Membrane 140 is pulled until bodymembers 110, 120 of access port 100 are positioned substantiallyparallel to the surface of tissue through which incision “I” has beenmade, as shown in FIG. 2A. Lateral translation of membrane 140 may thenbe effected such that opposed sides 112, 122 of body members 110, 120,respectively, align substantially with the opposing sides of theincision “I” and such that the passageway 190 defined between opposedsides 112, 122 of the body members 110, 120, respectively, aligns withthe incision “I,” as shown in FIG. 2B. More particularly, the outersides 113, 123 of body members 110, 120 are positioned adjacent to anddistal of the ribs “R,” while opposed sides 112, 122, definingpassageway 190 therebetween, are positioned adjacent and distal of theincision “I.” As mentioned above, one or more ribbons 130 may beprovided on horseshoe shaped leading end 107 or at other positions onaccess port 100 to facilitate removal of access port 100 aftercompletion of the procedure.

It should be noted that, as shown in FIG. 2B, when access port 100 isinserted and positioned within incision “I,” access port 100 is orientedsuch that the concave, outwardly facing surfaces 116, 126 of bodymembers 110, 120 are facing proximally (toward the incision “I”) andsuch that the convex, inwardly facing surfaces 117, 127 of body members110, 120 are facing distally (toward the thoracic body cavity “T”). Ascan be appreciated, in this orientation, the opposed sides 112, 122 ofbody members 110, 120, respectively, extend proximally at leastpartially toward the incision “I” due to the curved surfaces of bodymembers 110, 120. Flexible membrane 140 extends proximally from opposedsides 112, 122 of body members 110, 120, respectively. Morespecifically, and although not viewable in FIGS. 2A-2B, flexiblemembrane 140, having adjustable ring 150 disposed at a proximal endthereof, extends from opposed sides 112, 122 of body members 110, 120proximally through the incision “I.” Ring 150 is positioned adjacent anexternal surface of tissue and is initially disposed in the minimum,un-tensioned configuration, i.e., wherein ends 153, 154 aresubstantially overlapping to form a minimum diameter of ring 150. Thepositioning of ring 150 adjacent the external surface of tissue providesa desirable low-profile configuration that allows for greatermaneuverability of surgical instrumentation within access port 100.

From the position described above and shown in FIG. 2B, access port 100may be expanded from the approximated position to the open (spread)position to provide access to an internal body cavity, e.g., thethoracic cavity “T” (FIGS. 3 and 6). In order to expand the access port100 from the approximated position to the open position, adjustable ring150 is ratcheted, or expanded, from its minimum diameter to a largerdiameter. As can be appreciated, as ring 150 is expanded, ring 150tensions flexible membrane 140 and pulls flexible membrane 140proximally through the incision “I,” eventually pulling flexiblemembrane 140 radially outwardly from the incision “I” along the externalsurface of tissue. As flexible membrane 140 is tensioned and pulledproximally through the incision “I,” opposed sides 112 and 122 of bodymembers 110, 120, respectively, are pulled proximally through theincision “I” until flexible membrane 140 is no longer disposed throughincision “I” but, rather, completely extends along the external surfaceof tissue. Body members 110, 120 are thus disposed through the incision“I” with opposed sides 112, 122 extending toward a proximal end ofincision “I” and with outer sides 113, 123 extending toward a distal endof incision “I,” as shown in FIG. 3. The increased flexibility of bodymembers 110, 120 from outer ends 113, 123 to opposing ends 112, 122allows body members 110, 120 to be flexed in response to the tensioningand pulling of flexible membrane 140.

Moreover, horseshoe shaped connector 108 helps maintain outer sides 113,123 in position adjacent and distal of ribs “R.” In other words, outersides 113, 123 are retained within the thoracic cavity “T,” distal ofthe ribs “R,” while opposed sides 112, 122 are flexed proximally andapart from one another through the incision “I” in response to thepulling of flexible membrane 140 by the expansion of the adjustable ring150. Further, it is envisioned that grips (not explicitly shown) may bedisposed on the outwardly facing surfaces 116, 126 and, moreparticularly, lining the saddles 118, 128 of body members 110, 120,respectively, to anchor the body members 110, 120 in position and toprevent slippage.

As shown in FIG. 3, as adjustable ring 150 is moved toward a maximumdiameter, outwardly facing surfaces 116, 126 of body members 110, 120engage the tissue adjacent ribs “R” within saddles 118, 128 and urge thetissue “R” apart from one another to expand the intercostal space.Further, as can be appreciated, as opposed sides 112, 122 of bodymembers 110, 120 are flexed proximally and outwardly from one another toexpand tissue adjacent ribs “R,” the passageway 190 defined throughaccess port 100 is expanded from the approximated position defining aminimum width to a spread or open position, wherein the passageway 190defines a larger width, as best shown in FIG. 3. The locking mechanism,e.g., interlocking teeth 153 a, 154 a and notches 153 b, 154 b of ends153, 154 of ring 150, allows access port 100 to be retained in thespread position (FIG. 3). Further, the interlocking teeth 153 a, 154 aand notches 153 b, 154 b of ring 150 allow for locking of access port100 in a plurality of intermediate positions between the approximatedposition and the spread or open position. Such a feature accommodatesdifferent anatomies of different patients, i.e., their intercostalspacing may be different, and accounts for the desirability in someprocedures to urge the ribs “R” apart further, while in other proceduresto spread the tissue adjacent the ribs to provide access to the internalcavity without increasing the spacing between the adjacent ribs “R.”

Once access port 100 is retained or locked in the spread position asdescribed above, surgical instrumentation may be inserted throughpassageway 190 to perform the surgical procedure therein. As shown inFIG. 3, body members 110, 120 maintain passageway 190 while protectingthe incision “I” and the surrounding tissue. Ribs “R” and nerves “N” areprotected within saddles 118, 128 by the thickened portions of bodymembers 110, 120 and/or the additional cushioning 119. Flexible membrane140 extends radially outwardly from incision “I” and protects theexternal surface of tissue, while adjustable ring 150 maintains accessport 100 in the open position. Thus, the incision “I” and surroundingtissue is protected and the tissue adjacent ribs “R” retracted toprovide access to the thoracic cavity “T” with minimal pain to thepatient and minimal tissue damage. Additionally, as mentioned above, thelow-profile configuration of flexible membrane 140 and ring 150 allowsfor greater access to the thoracic cavity “T,” and for greatermanipulation of instrumentation disposed through passageway 190

The inwardly facing surfaces 117, 127 of the body members 110, 120,respectively, may be coated with a lubricant, or gel, to aid in theinsertion and removal of surgical instrumentation and/or tissuespecimens from access port 100.

A textured surface can optionally be placed on the outer (contact)surfaces 166, 126 to increase the grip on the intercostal tissue. Themembrane 140 can also optionally have a textured surface to enhancegripping of tissue.

Upon completion of the surgical procedure, adjustable ring 150 iscollapsed or “unlocked” and returned to the minimum diameter, therebyun-tensioning flexible membrane 140 and allowing body members 110, 120to return under the bias to the approximated, or closed, position shownin FIG. 2B, and allowing tissue adjacent ribs “R” to contract backtoward their initial position. As body members 110, 120 are returned tothe un-flexed, closed position, access port 100 returns to the thin,relatively flat shape characteristic of the approximated position. Inthis approximated position, access port 100 may be easily removed fromthe incision “I.” More specifically, ribbon 130 may be pulledproximally, thereby pulling horseshoe shaped leading end 107 of accessport 100 proximally and rotating access port 100 into removal position,as best shown in FIG. 4. Upon further translation of ribbon 130, asshown in FIGS. 5A-5B, access port 100, lead by horseshoe shaped leadingend 107 is translated proximally through the incision “I” until theaccess port 100 has been completely removed form the incision “I.”Finally, the incision “I” may be closed off, e.g., sutured closed.

Although described for use in thoracic procedures, it should also beunderstood that the access port described herein can be used in otherminimally invasive surgical procedures.

Persons skilled in the art will understand that the devices and methodsspecifically described herein and illustrated in the accompanyingfigures are non-limiting exemplary embodiments, and that thedescription, disclosure, and figures should be construed merelyexemplary of particular embodiments. It is to be understood, therefore,that the present disclosure is not limited to the precise embodimentsdescribed, and that various other changes and modifications may beeffected by one skilled in the art without departing from the scope orspirit of the disclosure. Additionally, it is envisioned that theelements and features illustrated or described in connection with oneexemplary embodiment may be combined with the elements and features ofanother without departing from the scope of the present disclosure, andthat such modifications and variations are also intended to be includedwithin the scope of the present disclosure. Accordingly, the subjectmatter of the present disclosure is not to be limited by what has beenparticularly shown and described, except as indicated by the appendedclaims.

1-20. (canceled)
 21. A surgical access assembly comprising: a bodyincluding first and second body members coupled by a connector, each ofthe first and second body members including an opposed side moveablebetween an approximated position in which the opposed sides of the firstand second body members are positioned adjacent one another and a spreadposition in which the opposed sides of the first and second body membersdefine a passageway therebetween; and an adjustable ring operablycoupled to each of the first and second body members and selectivelyadjustable from a first position to a second position to move theopposed sides of the first and second body members from the approximatedposition to the spread position.
 22. The surgical access assemblyaccording to claim 21, including a flexible membrane connecting thefirst and second body members with the adjustable ring such thatmovement of the adjustable ring from the first position to the secondposition draws the flexible membrane radially outwardly to move theopposed sides of the first and second body members from the approximatedposition to the spread position.
 23. The surgical access assemblyaccording to claim 0, wherein the flexible membrane is configured toextend from an outer side of the first body member to an outer side ofthe second body member.
 24. The surgical access assembly according toclaim 0, wherein the outer side of each of the first and second bodymembers includes cushioning configured to protect surrounding tissuewhen the first and second body members are disposed through an openingin tissue.
 25. The surgical access assembly according to claim 21,including a ribbon coupled to the connector and configured to manipulatepositioning of the first and second body members.
 26. The surgicalaccess assembly according to claim 21, wherein each of the first andsecond body members includes a leading end and a trailing end, andwherein the connector is connected to the leading ends of the first andsecond body members.
 27. The surgical access assembly according to claim21, wherein the opposed sides of the first and second body members arebiased toward the approximated position.
 28. The surgical accessassembly according to claim 21, wherein the adjustable ring includesoverlapping end segments, the overlapping end segments havingcooperating structure to releasably retain the adjustable ring in aplurality of positions between the first and second positions.
 29. Thesurgical access assembly according to claim 21, wherein the adjustablering has a first diameter in the first position and a second diameterlarger than the first diameter in the second position.
 30. A surgicalaccess assembly comprising: a first body member having a first innerside; a second body member having a second inner side opposing the firstinner side, the first and second body members configured for relativemovement to selectively adjust a dimension of a passageway definedbetween the first and second inner sides; and a ring operably coupled toeach of the first and second body members and being configured tocontrol the relative movement of the first and second body members. 31.The surgical access assembly according to claim 30, including a flexiblemembrane connecting the first and second body members with the ring. 32.The surgical access assembly according to claim 31, wherein the flexiblemembrane is configured to extend from an outer side of the first bodymember to an outer side of the second body member.
 33. The surgicalaccess assembly according to claim 30, wherein the first and second bodymembers are configured for relative movement between an approximatedposition defining a first dimension of the passageway and a spreadposition defining a second dimension of the passageway greater than thefirst dimension.
 34. The surgical access assembly according to claim 33,including a connector extending between and coupling the first andsecond body members.
 35. The surgical access assembly according to claim34, wherein the first and second body members are normally biased towardthe approximated position.
 36. The surgical access assembly according toclaim 34, including a ribbon coupled to the connector and configured tomanipulate the position of the surgical access assembly.
 37. Thesurgical access assembly according to claim 34, wherein each of thefirst and second body members includes a leading end and a trailing end,and wherein the connector is connected to the leading ends of the firstand second body members.
 38. The surgical assembly according to claim 0,wherein the ring includes a first end operably coupled with the firstbody member and a second end operably coupled with the second bodymember, the first and second ends overlapping one another and engagablewith one another to retain the ring in a plurality of positions betweenthe first and second positions.
 39. The surgical assembly according toclaim 38, wherein the ring includes a ratcheting mechanism to retain thering in the plurality of positions.
 40. The surgical assembly accordingto claim 30, wherein the ring has a first diameter in the first positionand a second diameter larger than the first diameter in the secondposition.